背景:血液透析(HD)的成功关键取决于动静脉瘘(AVF)的有效使用。精确的针刺技术对于减少并发症和确保功能性血管通路至关重要。
目的:本研究评估了护理咨询方案的有效性,将体格检查(PE)与多普勒超声(DUS)集成在一起,为患者准备第一次AVF针刺。
方法:葡萄牙国家卫生服务医院的横断面分析涉及30名新的HD患者,四名有经验的HD针刺护士和一名HD血管通路护士。这项研究检查了与包括系统性PE和DUS的训练有素的血管通路护士相比,四名护士评估成熟AVF的PE准确性。
方法:主要数据包含源自PE的AVF特征(检查,触诊,和听诊)和DUS发现(静脉深度,直径,和血液流动)。次要重点是评估护理咨询后护士感知的针刺复杂性的变化。
结果:护理咨询显着增强了对关键AVF特征的识别,如附属静脉(p=0.002),提高了AVF形态学评估的准确性。这导致确定更长的针刺轨迹(p=0.031)和更多的安全针刺点(p=0.016)。护士报告使用此方法后,感知的复杂性和潜在的不良事件显着降低(p=0.027)。
结论:在护理咨询框架中整合结构化PE和DUS可显著改善AVF针刺的准备。这种方法提高了AVF针刺的效率和安全性,并增强了HD设置中的护士信心和患者护理。
BACKGROUND: The success of haemodialysis (HD) critically depends on the effective use of arteriovenous fistulas (AVFs). The precise
needling technique is vital to minimise complications and ensure functional vascular access.
OBJECTIVE: This study assesses the effectiveness of a nursing consultation protocol, which integrates physical examination (PE) with Doppler Ultrasound (DUS), in preparing patients for the first AVF
needling.
METHODS: A cross-sectional analysis at a Portuguese National Health Service Hospital engaged thirty new HD patients, four HD needling experienced nurses and one HD vascular access nurse. This study examines the accuracy of PE in assessing the matured AVF by the four nurses compared to a trained vascular access nurse encompassing systematic PE and DUS.
METHODS: The primary data incorporated AVF characteristics derived from PE (inspection, palpation, and auscultation) and DUS findings (vein depth, diameter, and blood flow). A secondary focus was evaluating the change in nurses\' perceived
needling complexity following the nursing consultation.
RESULTS: The nursing consultation significantly enhanced the identification of crucial AVF features, such as accessory veins (p = 0.002), and improved the accuracy of AVF morphology assessments. This led to identifying longer
needling tracks (p = 0.031) and a higher number of safe
needling points (p = 0.016). Nurses reported a notable reduction in perceived complexity and potential adverse events following this method (p = 0.027).
CONCLUSIONS: Integrating structured PE with DUS in a nursing consultation framework significantly improves the preparation for AVF needling. This approach enhances the efficiency and safety of AVF
needling and boosts nurse confidence and patient care in HD settings.